Healthcare Provider Details

I. General information

NPI: 1134188519
Provider Name (Legal Business Name): AUDREY CHEN MOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY CHEN MD

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LONG BEACH BLVD
LONG BEACH CA
90807-2615
US

IV. Provider business mailing address

3900 LONG BEACH BLVD
LONG BEACH CA
90807-2615
US

V. Phone/Fax

Practice location:
  • Phone: 562-988-8668
  • Fax: 562-988-8660
Mailing address:
  • Phone: 562-988-8668
  • Fax: 562-988-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA86641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: